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Wu E, Kuehl TJ, Danford JM, Bird ET, Yandell PM. Postoperative prophylactic antibiotics for retropubic mid-urethral slings. Int Urogynecol J 2022; 33:897-902. [PMID: 34264355 DOI: 10.1007/s00192-021-04916-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES AND HYPOTHESIS The primary objective is to measure the difference in urinary tract infection (UTI) rates within 6 weeks of placement of a retropubic mid-urethral sling (RMUS) in the setting of various postoperative prophylactic antibiotic regimens. UTI rates were measured by antibiotic prescriptions to treat UTI and/or culture. Secondary aims included determining risk factors for postoperative UTI. METHODS A retrospective chart review from 2014 to 2016 was performed at Baylor Scott and White Medical Center-Temple for CPT code 57288. Univariate comparisons were performed using chi-square and Student's t-test. Logistic regression analysis was performed for UTI risk factors with univariate p values ≤ 0.1. RESULTS One hundred twelve subjects were included. Seventeen (15%) were treated for postoperative UTI. Postoperative prophylactic antibiotics included trimethoprim (39.3%), nitrofurantoin (31.3%), trimethoprim-sulfamethoxazole (5.4%), ciprofloxacin (2.7%), and cephalexin (1.8%). Ninety subjects were prescribed postoperative prophylactic antibiotics (80.4%). The postoperative UTI rate was not significantly different between those who were prescribed postoperative prophylactic antibiotics (16%) and those who were not (14%). None of the treatments showed a significant difference on postoperative UTI rate compared to no treatment. Significant risk factors for UTI included catheterization past postoperative day 1 (OR 6.4, 95% CI 1.7 - 23.8; p = 0.006). CONCLUSIONS There was no significant difference in postoperative UTI rate in the group without postoperative prophylactic antibiotics compared to those who did receive it. Catheterization past postoperative day 1 was significantly associated with postoperative UTI. However, definitive conclusions are limited by a lack of power.
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Affiliation(s)
- Emily Wu
- Division of Urogynecology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
| | - Thomas J Kuehl
- Department of Obstetrics and Gynecology, Baylor Scott and White Medical Center, Temple, TX, USA
| | - Jill M Danford
- Division of Urogynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Erin T Bird
- Department of Surgery, Division of Urology, Baylor Scott and White Medical Center, Temple, TX, USA
| | - Paul M Yandell
- Department of Obstetrics and Gynecology, Baylor Scott and White Medical Center, Temple, TX, USA
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Uberoi P, Lee W, Lucioni A, Kobashi KC, Berry DL, Lee UJ. Listening to Learn: A Qualitative Analysis of Women's Experiences with Mesh Mid-urethral Sling Surgery. Urology 2022; 161:36-41. [PMID: 34929240 DOI: 10.1016/j.urology.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To improve women's experiences with mesh mid-urethral sling (MUS) surgery for treatment of stress urinary incontinence (SUI), we sought to qualitatively examine patient perspectives of MUS surgery, organize resulting patient-derived themes, and present our findings as potential springboards for future research and quality improvement efforts. METHODS We conducted semi-structured focus groups and interviews of patients who had undergone mesh MUS surgery at a single tertiary referral institution. Discussions were recorded, transcribed, de-identified, and analyzed using deductive and inductive content analysis. Two researchers independently performed line-by-line coding which was verified by two additional researchers. RESULTS Eleven women participated. Most sought SUI care after becoming frustrated with their symptoms. However, some participants experienced barriers to care or dismissal of their symptoms by their physicians. While participants expected improvements in SUI symptoms after MUS surgery, some expected improvement or resolution of other pelvic floor-related issues such as bowel symptoms. Despite having improved SUI symptoms, participants described non-SUI symptoms as negative outcomes from their MUS surgery. Overall, participants wished SUI-associated embarrassment could be lessened and suggested public service announcements to help normalize discussion of SUI symptoms. CONCLUSION Obtaining first-hand information from SUI patients who have undergone MUS surgery provides insights into what matters to patients. Information from this study can help support further investigation into barriers to care for SUI patients and further study into improving counseling on goals and expectations of MUS surgery. The themes complement the current knowledge on MUS by providing insights that can only be collected through open-ended inquiry.
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Affiliation(s)
- Pansy Uberoi
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Wai Lee
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Alvaro Lucioni
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Kathleen C Kobashi
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
| | - Una J Lee
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA.
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Cost-effectiveness Analysis of Early Sling Loosening Versus Delayed Sling Lysis in the Management of Voiding Dysfunction After Midurethral Sling Placement. Female Pelvic Med Reconstr Surg 2022; 28:e103-e107. [PMID: 35272342 DOI: 10.1097/spv.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to perform a cost-effectiveness analysis comparing the management for ongoing voiding dysfunction after midurethral sling placement, including early sling loosening and delayed sling lysis. METHODS A Markov model was created to compare the cost-effectiveness of early sling loosening (2 weeks) versus delayed sling lysis (6 weeks) for the management of persisting voiding dysfunction/retention after midurethral sling placement. A literature review provided rates of resolution of voiding dysfunction with conservative management, complications, recurrent stress urinary incontinence, or ongoing retention, as well as quality-adjusted life years (QALYs). Costs were based on 2020 Medicare reimbursement rates. Incremental cost-effectiveness ratios were compared using a willingness-to-pay threshold of $100,000/QALY. One-way and probabilistic sensitivity analyses were performed. RESULTS At 1 year, early sling loosening resulted in increased costs ($3,575 vs $1,836) and higher QALYs (0.948 vs 0.925) compared with delayed sling lysis. This translated to early sling loosening being the most cost-effective strategy, with an incremental cost-effectiveness ratio of $74,382/QALY. The model was sensitive to multiple variables on our 1-way sensitivity analysis. For example, delayed sling lysis became cost-effective if the rate of voiding dysfunction resolution with conservative management was greater than or equal to 57% or recurrent stress urinary incontinence after early loosening was greater than or equal to 9.6%. At a willingness-to-pay threshold of 100,000/QALY, early sling loosening was cost-effective in 82% of microsimulations in probabilistic sensitivity analysis. CONCLUSIONS Early sling loosening represents a more cost-effective management method in resolving ongoing voiding dysfunction after sling placement. These findings may favor early clinical management in patients with voiding dysfunction after midurethral sling placement.
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Incidence of Midurethral Sling Revision or Removal by Its Timing With Prolapse Surgery. Female Pelvic Med Reconstr Surg 2022; 28:379-384. [PMID: 35113050 DOI: 10.1097/spv.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate incidence of midurethral sling removal/revision based on timing with surgery for pelvic organ prolapse. METHODS This was a retrospective cohort study of women who underwent midurethral sling placement in a claims-based database of women 65 years or older. Three groups were identified using the Current Procedural Terminology codes: (1) isolated sling, (2) concomitant sling, and (3) prolapse surgery and staged sling after prolapse surgery. In the staged group, placement of sling was identified within 18 months after index prolapse surgery. Fascial grafts were excluded. Sling removal/revision was identified across 3 years after sling surgery using Current Procedural Terminology code 57287. Rates of sling removal/revision were calculated by group. Comparisons were made using the χ2 test and analysis of variance. Cumulative incidence of removal/revision was evaluated using the Kaplan-Meier curves. Cox proportional hazards was performed to evaluate factors influencing removal/revision. RESULTS We identified 39,381 isolated MUSs, 25,389 concomitant, and 886 staged. The rate of sling removal/revision was 3.52%. Rates of removal/revision differed between groups (7% staged vs 3.94% concomitant vs 3.17% isolated sling, P < 0.001). Compared with the staged group, the rate of removal/revision was lower in the isolated sling group (relative risk, 0.4550; 95% confidence interval [CI], 0.358-0.568) and the concomitant group (relative risk, 0.5666; 95% CI, 0.4450-0.7287). After adjusting for patient characteristics, sling revision or removal remained significantly less in the isolated MUS (hazard ratio, 0.50; 95% CI, 0.39-0.65) and concomitant (odds ratio, 0.55; 95% CI, 0.43-0.71) groups. CONCLUSIONS Sling removal/revision is higher when it is staged after prolapse surgery compared with isolated and concomitant placement. Future studies are needed to confirm these findings in a controlled population.
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Huang Z, Yang T, Shao L, Yang B, Yang S, Wang G, Li P, Li J. Regenerated Cell Therapy for Stress Urinary Incontinence: A Meta-Analysis. J INVEST SURG 2020; 34:1366-1376. [PMID: 33198535 DOI: 10.1080/08941939.2020.1805654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of regenerated cell therapy for stress urinary incontinence (UI) in humans. METHODS We searched articles from PubMed, Embase, and the Cochrane Library database published before February 24, 2020. Of 396 records identified, 23 articles on human clinical research met our criteria, including a total of 890 patients. Stata/SE12.0 software was used to analyze cure, efficiency (cure rate plus improvement rate), and complication rates. RESULTS No significant differences in cure rates and effective rates were observed for any cell type in males. However, in females, the myocytes with fibroblasts subgroup (82%) and nucleated cells with platelets subgroup (89%) exhibited significantly higher cure rates compared with the other two subgroups (25% and 36%). Pooled effective rates of myocytes and fibroblasts (92%) and nucleated cells with platelets (97%) were also higher compared with the other two subgroups (72% and 60%). Pooled complication rates were 23% and 26% in males and females, respectively, and there were some differences among subgroups. Although some studies reported postoperative complications, no serious complications were reported and most recovered within 1-2 weeks. CONCLUSIONS Limited studies have indicated the safety and effectiveness of regenerated cells for treating stress UI in the follow-up period, which may be an ideal method to treat stress UI in the future. Moreover, nucleated cells with platelets and myocytes with fibroblasts were markedly effective, but whether cell injection therapies elicit superior effects need further confirmation.
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Affiliation(s)
- Ziye Huang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Tongxin Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Lishi Shao
- The Department of Imageology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Bowei Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Shunhang Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Guang Wang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Pei Li
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Jiongming Li
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
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Cisneros-Pérez J, Yusta-Martín G, Sánchez-Conde MP, Padilla-Fernandez BY, Valverde-Martínez LS, Martin-Hernandez M, Prieto Nogal S, Flores-Fraile J, Esteban-Fuertes M, García-Cenador MB, Lorenzo-Gómez MF. The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape. J Clin Med 2020; 9:jcm9082607. [PMID: 32796713 PMCID: PMC7464496 DOI: 10.3390/jcm9082607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Stress urinary incontinence (SUI) has an incidence of 15-80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoperative or postoperative complications, which can have an impact on functional recovery, understood as the return to routine life prior to the intervention. AIMS To assess the time for functional recovery in women operated on for SUI by TOT; to identify complications and related factors, according to anaesthetic risk, which condition the time to functional recovery; and proposals for improvements in the prevention of possible complications and in reducing functional recovery time. MATERIALS AND METHODS A non-concurrent prospective observational multicenter study of 891 women undergoing TOT for stress urinary incontinence since 1 April 2003, who were successful in achieving urinary continence (completely dry). Study groups: GA (n = 443): patients with ASA I risk. GB (n = 306): patients with ASA II risk. GC (n = 142): patients with anaesthetic risk ASA III. Investigated variables: age, body mass index, follow-up time, secondary diagnoses, surgical history, obstetric-gynecological history, toxic habits, and complications derived from surgery: bleeding, pain, infection. Descriptive statistics, Student's t test, Chi2, Fisher, ANOVA, multivariate analysis, significance for p < 0.05. RESULTS Mean age was 60.10 years (SD13.38), with no difference between groups. Mean body mass index (BMI) was 26.55 kg/m2 (SD 4.51), lowest in GA. GB had more HT (38.6%) than GC (23.23%), more type 2 diabetes (19.83% versus 10.56%), and more respiratory disorders (6.97% versus 2.11%). There were more women with anxiety in GB (19.3%) than in GC (6.33%) (p = 0.0221) and GA (10.51%) (p = 0.0004). There was more hypothyroidism in GB (16.08%) compared to GC (2.11%) and GA (9.07%). There was more history of curettage in GC (11.97%) versus GB (5.63%); and more pelvic surgery in GB (71.31%) and GC (66.9%) compared to GA (32.57%). There were more concomitant treatments with benzodiazepines in GC (27.46%) and GB (28.41%) than in GA (8.86%), and more parapharmacy treatments in GB (17.96%) than in GC (6.33%). Following the operation, 113 patients had some sign or symptom that required medical attention: in GA 48 (10.83%), in GB 49 (16.06%), in GC 16 (13.22%). Mean days until functional recovery in patients with complications: in GA 5.72 (SD2.05); bleeding 3 (SD1), pain 6.40 (SD1.34), and infection 7.33 (SD0.57), with fewer days for bleeding than for pain or infection. GB: 27.96 (SD 28.42), bleeding 3 (SD0), pain 46.69 (SD31.36), infection 10.83 (SD3.90); lowest for patients with bleeding. GC: 9.44 (SD 2.50); for bleeding 7.66 (SD2. 08), pain 10.66 (SD1.15), infection 10 (SD3.46); no differences. Overall, for women with bleeding, the time was 4.16 days (SD1.94); less in GA and GB than in GC. Pain, at 31.33 days (SD 30.70), was the factor that most delayed functional recovery; in GB women, it took longer to return to work due to pain (45.96, SD31.36) compared to GA (6.4, SD 1.34) and GC (10.66, SD1.15). In women with infection, overall mean time was 10.11 days (SD 3.61) with no difference between groups. CONCLUSIONS Mean time for the return to normal activity in patients who underwent TOT for SUI is 5 days if there are no complications, and 16.91 days if there are any. The ASA-SP risk group classification can be used to anticipate functional outcomes. An ASA-PS risk-based functional recovery forecasting protocol should be adapted, especially ASA II patients who may present with long-term disabling postoperative pain. Preventive management measures are proposed that favour functional recovery.
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Affiliation(s)
- Juan Cisneros-Pérez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
| | - Gemma Yusta-Martín
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Department of Anesthesiology of University Hospital of Salamanca, 37007 Salamanca, Spain
| | - María-Pilar Sánchez-Conde
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Department of Anesthesiology of University Hospital of Salamanca, 37007 Salamanca, Spain
| | | | - Lauro-Sebastian Valverde-Martínez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR) of the Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology, University Hospital of Ávila, 05071 Ávila, Spain;
| | - Mario Martin-Hernandez
- Renal Urological Multidisciplinary Research Group (GRUMUR) of the Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology, University Hospital of Ávila, 05071 Ávila, Spain;
| | - Sara Prieto Nogal
- Department of Urology, University Hospital of Ávila, 05071 Ávila, Spain;
| | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Correspondence:
| | - Manuel Esteban-Fuertes
- Department of Urology of National University Hospital of Paraplegic, 45004 Toledo, Spain;
| | - María-Begoña García-Cenador
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
| | - María-Fernanda Lorenzo-Gómez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (J.C.-P.); (G.Y.-M.); (M.-P.S.-C.); (L.-S.V.-M.); (M.-B.G.-C.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR) of the Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology of University Hospital of Salamanca, 37007 Salamanca, Spain
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Risk Factors for Returning to the Operating Room for a Second Surgery After Midurethral Sling for Stress Urinary Incontinence. Female Pelvic Med Reconstr Surg 2020; 26:443-446. [DOI: 10.1097/spv.0000000000000804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Systematic Review of Frailty Assessments in Women With Pelvic Floor Disorders: Are We Following the American College of Surgeons National Surgical Quality Improvement Program/American Geriatric Society Guidelines? Female Pelvic Med Reconstr Surg 2019; 24:135-141. [PMID: 29474287 DOI: 10.1097/spv.0000000000000508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Associations between frailty and women with pelvic floor disorders (PFDs) are not well understood. This study seeks to describe studies among women with PFD and the associated frailty assessments as recommended in the American College of Surgeons National Surgical Quality Improvement Program/American Geriatric Society (ACS NSQIP/AGS) guidelines. METHODS This systematic review was registered with PROSPERO using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The GRADE (Grading of Recommendations, Assessment, Development and Evaluations) criteria are applied to assess study quality. Data synthesis is descriptive. Outcomes of interest include the ratio of studies adhering to the ACS NSQIP/AGS guidelines and evidence for frailty assessments versus usual care for women with PFDs. RESULTS Twenty studies regarding frailty and PFDs were included for systematic review. Studies were categorized as relating to (1) epidemiology, (2) frailty and incontinence, (3) postoperative morbidity, and (4) surgical choice. Most studies (5/20) did not define frailty or failed to follow the ACS NSQIP/AGS guidelines. All studies were of very low to low quality. Collectively, each category generated very low GRADE quality evidence of frailty and the relationship to PFDs. CONCLUSIONS Most studies regarding frailty among women with PFDs did not define frailty as recommended in the ACS NSQIP/AGS guidelines. The evidence regarding PFDs and frailty is of very low quality. This is the first systematic review regarding frailty assessments specifically among women with PFDs. Paucity of data regarding frailty in women with PFDs, particularly with regard to surgical choice and surgical counseling, highlights the need for further study in this area.
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James MB, Theofanides MC, Sui W, Onyeji I, Badalato GM, Chung DE. Sling Procedures for the Treatment of Stress Urinary Incontinence: Comparison of National Practice Patterns between Urologists and Gynecologists. J Urol 2017; 198:1386-1391. [DOI: 10.1016/j.juro.2017.06.093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Maxwell B. James
- Department of Urology, Columbia University Medical Center, New York, New York
| | | | - Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Ifeanyi Onyeji
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Gina M. Badalato
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Doreen E. Chung
- Department of Urology, Columbia University Medical Center, New York, New York
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Dallas KB, Sohlberg EM, Elliott CS, Rogo-Gupta L, Enemchukwu E. Racial and Socioeconomic Disparities in Short-term Urethral Sling Surgical Outcomes. Urology 2017; 110:70-75. [DOI: 10.1016/j.urology.2017.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/02/2017] [Accepted: 08/15/2017] [Indexed: 12/24/2022]
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Thirty-day Morbidity of Abdominal Sacrocolpopexy Is Influenced by Additional Surgical Treatment for Stress Urinary Incontinence. Urology 2017; 109:82-87. [DOI: 10.1016/j.urology.2017.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/19/2022]
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Rechberger T, Wrobel A, Zietek A, Rechberger E, Bogusiewicz M, Miotla P. Transobturator midurethral sling: What should patients expect after surgery? Int Urogynecol J 2017; 29:55-61. [PMID: 28689238 PMCID: PMC5754394 DOI: 10.1007/s00192-017-3408-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/19/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Midurethral sling (MUS) surgeries are minimally invasive procedures; however, they are not free of postoperative complications. The aim of the study was to assess the occurrence of lower urinary tract symptoms (LUTS) (urgency, nocturia, frequency, splitting/spraying, hesitancy, terminal dribbling, and subjective feeling of postvoid residual) in patients suffering from stress (SUI) or mixed (MUI) urinary incontinence with a predominant SUI component before and after transobturator MUS placement. METHODS The study group consisted of 88 women with SUI and 18 with MUI who underwent transobturator MUS. All participants were questioned with a self-developed questionnaire before and after surgery regarding the presence of LUTS. RESULTS Seven days after surgery, 62 patients (58.5%) noted voiding and postmicturition symptoms, whereas 67 (63.2%) reported problems in storage. The more commonly reported LUTS at week 1 after surgery were urgency (52.8%), splitting/spraying (41.5%), and feeling of incomplete bladder emptying (34.0%). Patients perceived that splitting/spraying was the most bothersome. After 6 months, the most common LUTS reported were hesitancy (14.1%), terminal dribbling (10.4%), and splitting/spraying (9.4%). We noticed a decrease in the number of urgency episodes >2.7 times (p < 0.001) compared with baseline. After 6 months, 97 (91.5%) patients reported the lack of incontinence episodes. CONCLUSIONS A vast majority of patients after MUS suffer from LUTS in the early postoperative period; however, the majority of undesired symptoms resolve spontaneously within the first 6 months postsurgery.
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Affiliation(s)
- Tomasz Rechberger
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Andrzej Wrobel
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Alicja Zietek
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Ewa Rechberger
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Michal Bogusiewicz
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Pawel Miotla
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland.
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Hengel AR, Carlson KV, Baverstock RJ. Prevention, diagnosis, and management of midurethral mesh sling complications. Can Urol Assoc J 2017; 11:S135-S140. [PMID: 28616113 DOI: 10.5489/cuaj.4639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Midurethral slings (MUS) are a proven effective treatment option for stress urinary incontinence (SUI) and have become the gold standard in most centres in North America. MUS implantation can be associated with risks that are common to all anti-incontinence surgeries, and others which are unique. This article reviews the intraoperative and the early and late postoperative risks associated with these procedures, with insights into their prevention, diagnosis, and management drawn from the literature and expert opinion. In most cases, careful patient counselling before and after surgery, along with meticulous surgical technique, can mitigate risk and patient concern. Even in the best of hands, however, complications will occur, so surgeons must have a high index of suspicion and a low threshold to investigate.
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Affiliation(s)
- A Ross Hengel
- Faculty of Medicine, University of British Columbia, Prince George, BC; Canada
| | - Kevin V Carlson
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB; Canada
| | - Richard J Baverstock
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB; Canada.,vesia [Alberta Bladder Centre], Calgary, AB; Canada
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Affiliation(s)
- Sender Herschorn
- Division of Urology University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Dallas KB, Rogo-Gupta L, Elliott CS. Unplanned Hospital Visits in the First 30 Days After Urethral Sling Procedures. Urology 2017; 103:79-83. [PMID: 28153590 DOI: 10.1016/j.urology.2017.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/12/2017] [Accepted: 01/24/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate unplanned hospital visits within 30 days of urethral sling placement in the form of emergency department visits, inpatient admissions, or repeat surgery. METHODS We accessed nonpublic data from the Office of Statewide Health Planning and Development in the state of California for the years 2005-2011. All female patients who underwent an ambulatory urethral sling procedure (Current Procedural Terminology 57288) without concomitant surgery (other than cystoscopy) were included. Any subsequent emergency department visit, inpatient admission, or sling revision operation within 30 days of the original surgery were then examined. RESULTS A total of 28,635 women were identified who underwent outpatient urethral sling placement as a sole procedure. Within 30 days, 1630 women (5.7%) had at least 1 unplanned hospital visit. This included 1327 emergency department visits (4.7%), 295 inpatient admissions (1.0%), and 79 sling revisions (0.28%). Urinary retention and Foley catheter problems were the most common emergency department visit diagnoses (18.7% of visits), followed by urinary tract infection (9.3% of visits). CONCLUSION One in 18 women will have an unplanned hospital visit within 30 days of urethral sling placement, the majority of which are emergency department visits (~81%). Our findings can be used to improve patient counseling and suggest areas that one might target to decrease unnecessary emergency department visits in the early postoperative period.
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Affiliation(s)
- Kai B Dallas
- Stanford University School of Medicine, Stanford, CA.
| | | | - Christopher S Elliott
- Stanford University School of Medicine, Stanford, CA; Santa Clara Valley Medical Center, San Jose, CA
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Gomelsky A. Editorial Comment. Urology 2016; 95:78. [DOI: 10.1016/j.urology.2016.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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